Tearing during childbirth: what you need to know

Childbirth can lead to physical changes and challenges, particularly on the pelvic floor. One of the most common injuries is perineal tears, which occur during vaginal delivery. These tears can have a significant impact on pelvic floor muscle function. Perineal tears occur in the perineum, the area between the vaginal opening and the anus, during vaginal delivery. They are classified into four degrees:  

• First-degree tears involve only the vaginal mucosa (the inner lining). 

• Second-degree tears extend through the vaginal muscles. 

• Third-degree tears involve the vaginal muscles and the anal sphincter. 

• Fourth-degree tears extend through the anal sphincter and into the rectal mucosa.  

The severity of the tear determines the treatment and recovery process. While first-degree tears may heal with minimal intervention, second to fourth-degree tears often require stitches immediately after delivery, occasionally a surgical repair, and a more extended recovery period.  

When perineal tears occur, they can disrupt the integrity and function of the pelvic floor muscles. The extent of the impact depends on the degree of the tear and the effectiveness of the repair. Perineal tears can affect pelvic floor function in multiple ways. 

•  Muscle Weakness and Dysfunction: Tears that extend into the pelvic floor muscles can weaken these muscles and surrounding structures, leading to reduced support for the pelvic organs. This weakness can contribute to urinary, fecal or gas leaking, or pelvic organ prolapse. 

•  Scar Tissue Formation: Scar tissue has less mobility and tensile strength than the original muscle tissue, which can result in reduced elasticity and function. This may lead to pain surrounding the scar or decreased strength of the surrounding muscles.  

• Pain and Discomfort: Pain or discomfort in the perineal area can contribute to painful intercourse or discomfort during physical activities.  

• Decreased Muscle Coordination: The trauma of a tear and subsequent repair can impact the coordination of the pelvic floor muscles. Proper muscle coordination is essential for activities such as bladder control and support during physical activities. 

 Recovery from perineal tears and maintaining pelvic floor health should include a visit with a pelvic health physical therapist.  A pelvic floor physical therapist will provide a personalized treatment plan addressing muscle weakness, coordination issues, and pain. They will also offer strategies for scar tissue management.  Postpartum recovery can be a gradual return to physical activity.  A pelvic floor physical therapist can help you through the process and develop an exercise program and treatment plan that is right for you and your goals.  

For more insight into treatment, check out our previous blog on Perineal Tears. To schedule a Free 15 minute consultation or an evaluation with one of our specialists in women’s health click HERE.